Aéroportie au cours de l'acidocétose diabétique : un signe d'ischémie mésentérique sévère

Hepatic portal venous gas, an ominous radiologic sign, is associated in some cases with a severe underlying abdominal disease as a bowel ischemia. Prognosis and treatment depend on its aetiology. We present a 48-year-old woman with diabetes mellitus, who is admitted to the hospital because of a semi comatose state and abdominal pains. The first laboratory test results show an hyperglycemia, glycosuria, ketonuria, a metabolic acidosis with hyperlactatémia (9 mmol/l), hyperkaliemia (potassium: 8,7 mmol/l) and an acute renal failure. In view of this diabetic ketoacidosis, a rehydratation and an insulinotherapy are introduced allowing an improvement of the biological status but the clinical state of the patient degrades: hemodynamic instability, abdominal pain and increased blood lactic acid. The abdominal CT realized 12 hours after her admission shows up a hepatic portal venous gas associated with pneumatosis intestinalis. The surgery has shown a massive ischemic intestinal necrosis.